Fujiwara Kana, Aoki Shigeru, Kurasawa Kentaro, Okuda Mika, Takahashi Tsuneo, Hirahara Fumiki
Perinatal Center for Maternity and Neonatal, Yokohama City University Medical Center, Yokohama, Japan.
J Obstet Gynaecol Res. 2014 Apr;40(4):988-94. doi: 10.1111/jog.12283. Epub 2014 Jan 15.
To determine associations of maternal pre-pregnancy underweight with poor outcomes and evaluate how gestational weight gain affects risks for such outcomes in pre-pregnancy underweight Japanese women.
By analyzing the January 2001-December 2012 hospital database, we retrospectively identified 6954 women with pre-pregnancy normal weights (body mass index, 18.5-24.9 kg/m²) and 1057 pre-pregnancy underweight women (body mass index, <18.5 kg/m²) who delivered at the Perinatal Maternity and Neonatal Center of Yokohama City University. These women were stratified by weekly weight gain during the second/third trimesters to investigate associations of gestational weight gain with spontaneous preterm birth and small for gestational age (SGA). Spontaneous preterm birth and SGA incidences were compared with those of women meeting Institute of Medicine (IO M) guidelines to determine optimal weight gain in Japanese women.
Preterm birth and SGA incidences were significantly higher in pre-pregnancy underweight than in pre-pregnancy normal weight women (4.6% vs 2.4% [P=0.005] and 13.9% vs 9.7% [P = 0.003], respectively). For pre-pregnancy normal weight women, preterm birth incidence was significantly higher in those with weight gain of less than 0.2 kg/week than in those IOM guidelines. For pre-pregnancy underweight women, preterm birth and SGA incidences were significantly higher in those with weight gain of less than 0.3 kg/week than in those meeting IOM guidelines.
Preterm birth and SGA incidences did not differ significantly between pre-pregnancy normal weight women with weight gain of 0.2 kg/week or more and pre-pregnancy underweight women with weight gain of 0.3 kg/week or more, as compared to women meeting IOM guidelines. These results suggest that IOM guidelines for gestational weight gain may lack external validity in Japanese women.
确定孕前体重过轻与不良结局之间的关联，并评估孕期体重增加如何影响日本孕前体重过轻女性出现此类结局的风险。
通过分析2001年1月至2012年12月的医院数据库，我们回顾性地确定了在横滨市立大学围产期母婴和新生儿中心分娩的6954名孕前体重正常（体重指数，18.5 - 24.9 kg/m²）的女性和1057名孕前体重过轻（体重指数，<18.5 kg/m²）的女性。这些女性按孕中期/孕晚期每周体重增加情况进行分层，以研究孕期体重增加与自发性早产和小于胎龄儿（SGA）之间的关联。将自发性早产和SGA的发生率与符合美国医学研究所（IOM）指南的女性的发生率进行比较，以确定日本女性的最佳体重增加量。
孕前体重过轻的女性早产和SGA的发生率显著高于孕前体重正常的女性（分别为4.6%对2.4% [P = 0.005]和13.9%对9.7% [P = 0.003]）。对于孕前体重正常的女性，每周体重增加少于0.2 kg的女性早产发生率显著高于符合IOM指南的女性。对于孕前体重过轻的女性，每周体重增加少于0.3 kg的女性早产和SGA的发生率显著高于符合IOM指南的女性。
与符合IOM指南的女性相比，每周体重增加0.2 kg或更多的孕前体重正常女性和每周体重增加0.3 kg或更多的孕前体重过轻女性之间，早产和SGA的发生率没有显著差异。这些结果表明，IOM关于孕期体重增加的指南在日本女性中可能缺乏外部有效性。
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